Background and Aims: The metabolic
acid-base disorders have a high incidence of
acute kidney injury (AKI) in
critically ill cirrhotic patients (CICPs). The aims of our study were to ascertain the composition of
metabolic acidosis of CICPs with AKI and explore its relationship with hospital mortality. Methods: Three-hundred and eighty consecutive CICPs with AKI were eligible for the cohort study. Demographic, clinical and laboratory parameters were recorded and arterial
acid-base state was analyzed by the Stewart and Gilfix methodology. Results: Net
metabolic acidosis,
lactic acidosis,
acidosis owing to unmeasured
anions, acidemia, and dilutional
acidosis were less frequent in the non-survival group compared to the survival group of CICPs. The presence of acidemia,
acidosis owing to unmeasured
anions, and
lactic acidosis were independently associated with increased risk of intensive care unit 30-day mortality, with hazard ratios of 2.11 (95% confidence interval (CI): 1.43-3.12), 3.38 (95% CI: 2.36-4.84), and 2.16 (95% CI: 1.47-3.35), respectively. After full adjustment for confounders, the relationship between
acidosis owing to unmeasured
anions with hospital mortality was still significant, with hazard ratio of 2.29 (95% CI: 1.22-4.30). Furthermore, arterial
lactate concentration in combination with
chronic liver failure-sequential organ failure assessment and BEUMA had the strongest ability to differentiate 30-day mortality (area under the receiver operating characteristic curve: 0.79, 95% CI: 0.74-0.83). Conclusions: CICPs with AKI exhibit a complex
metabolic acidosis during intensive care unit admission.
Lactic acidosis and BEUMA, novel markers of
acid-base disorders, show promise in predicting mortality rate of CICPs with AKI.